Chemotherapy Drug Classes for NCLEX: Alkylating Agents, Antimetabolites & More
Review chemotherapy drug classes for the NCLEX exam. Learn alkylating agents, antimetabolites, plant alkaloids, and key nursing considerations.
Chemotherapy Drug Classes for NCLEX Review
Chemotherapy pharmacology is a complex but important NCLEX topic. Understanding drug classifications, mechanisms of action, and nursing considerations helps you answer questions about oncology care confidently.
Alkylating Agents
Alkylating agents (cyclophosphamide, cisplatin, carboplatin) work by cross-linking DNA strands, preventing cell replication. They are cell cycle non-specific, meaning they affect cells in any phase of division. Cyclophosphamide can cause hemorrhagic cystitis, so ensure adequate hydration and administer mesna as a uroprotective agent. Cisplatin is highly emetogenic and nephrotoxic, requiring aggressive hydration and antiemetic prophylaxis. Monitor renal function closely and assess for ototoxicity (hearing loss, tinnitus).
Antimetabolites
Antimetabolites (methotrexate, 5-fluorouracil, cytarabine) mimic normal cell metabolites and interfere with DNA and RNA synthesis. They are cell cycle specific (S phase). Methotrexate toxicity is treated with leucovorin (folinic acid) rescue. Monitor for stomatitis, myelosuppression, and hepatotoxicity. 5-FU commonly causes hand-foot syndrome (palmar-plantar erythrodysesthesia) presenting as redness, swelling, and pain on palms and soles.
Plant Alkaloids
Vinca alkaloids (vincristine, vinblastine) inhibit microtubule formation during mitosis (M phase specific). Vincristine is known for peripheral neuropathy (numbness, tingling, constipation). Monitor for decreased deep tendon reflexes. These are vesicants and cause severe tissue damage if extravasation occurs. Taxanes (paclitaxel, docetaxel) stabilize microtubules and prevent cell division. They require premedication with corticosteroids and antihistamines to prevent hypersensitivity reactions.
Nursing Responsibilities
Verify informed consent before chemotherapy administration. Confirm the drug, dose, route, and schedule against the treatment protocol. Monitor for extravasation at the IV site: stop the infusion immediately if swelling, pain, or redness occurs. Follow facility protocol for extravasation management including cold or warm compresses depending on the drug. Document nadir dates and schedule lab draws accordingly. For comprehensive review, use our pharmacology mini-exams and explore oncology pharmacology topics.